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Jurnal Anestesi Obstetri Indonesia
Published by Indonesian Society of Obstetric Anesthesia and Critical Care
ISSN : -     EISSN : 2615370X     DOI : https://doi.org/10.47507/obstetri.v3i2
Core Subject : Health, Science,
Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health
We accept manuscripts in the form of Original Articles, Case Reports, Literature Reviews, both from clinical or biomolecular fields, as well as letters to editors in regards to Obstetric Anesthesia and Critical Care. Manuscripts that are considered for publication are complete manuscripts that have not been published in other national journals. Manuscripts that have been published in the proceedings of the scientific meeting can still be accepted provided they have written permission from the organizing committee. This journal is published every 6 months with 8-10 articles (March, September) by Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC).
Arjuna Subject : Kedokteran - Anesthesiology and Pain Medicine
Articles 9 Documents
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Search results for , issue "Vol 4 No 1 (2021): Maret" : 9 Documents clear
Anesthesic Management in Pregnant Woman with Eisenmenger Syndrome Stefi Soefviana; Ardi Zulfariansyah
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.51

Abstract

The mortality rate in pregnant woman with cardiovascular disease is high.1 Eisenmenger syndrome is a congenital heart disease with a shunt abnormality between the systemic and pulmonary circulation where pulmonary hypertension occurs with right to left shunt at the level of the atria, ventricles or aortopulmonary arteries.2 Patients with Eisenmenger syndrome have a mortality rate up to 56% .1 A 29 years old woman, Gravida 28-29 weeks with a history of congenital heart disease Atrial Septal Defect (ASD) Secundum 27mm-35mm, moderate tricuspid regurgitation, severe pulmonary hypertension with MPAP 78mmHg, ejection fraction (EF) 88%, by bidirectional shunt with Eisenmenger syndrome. The patient underwent elective cesarean section under general anesthesia using Ketamine, Midazolam and Atracurium. The duration of surgery is about 1 hours with stable hemodynamics, EtCO2 within normal limits and no desaturation with a total bleeding of 350 cc. A baby boy was born with a weight range of 1100gr with an APGAR Score of 6/8. Extubation is done by deep extubation. For postoperative, the patient was transferred to the CICU for 3 days for hemodynamic monitoring and moved to the ward for 1 day of treatment and the patient went home. Pregnancy with Eisenmenger syndrome has a high mortality rate. Multidisciplinary team management is required in both elective surgery and the emergency department. Both general and regional anesthesia have their advantages and disadvantages. The principle of anesthesia management is to maintain the balance of the PVR and SVR so that there is no right to left shunt that causes death. Key words: cesarean section, congenital heart disease, Eisenmenger syndrome
Manajemen Nyeri Terkini pada Pasien Pasca Seksio Sesarea Muh Ramli Ahmad; Rezki Hardiyanti Taufik
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.53

Abstract

Prosedur Seksio Sesarea (SS) seringkali menyebabkan nyeri sedang hingga berat selama 48 jam. Tujuan manajemen nyeri pascabedah adalah untuk memberikan kenyamanan pada pasien, menghambat impuls nosiseptif, dan menumpulkan respon neuroendokrin terhadap nyeri, yang dengan demikian mempercepat kembalinya fungsi fisiologis. Selain itu, manajemen nyeri yang adekuat pada pasien SS memungkinkan mobilisasi dini untuk mencegah risiko tromboemboli yang meningkat selama kehamilan dan pasien perlu bebas nyeri untuk merawat bayi serta memberikan ASI secara efektif. Mekanisme nyeri pascabedah terdiri dari sensitisasi perifer dan senstisasi sentral dari susunan saraf. Dampak klinik sensitisasi sistem saraf berupa hiperalgesia dan alodinia. Sensitisasi pascabedah akan mengakibatkan penderitaan bagi pasien sehingga pada akhirnya dapat meningkatkan angka morbiditas dan mortalitas pascabedah, oleh karena itu manajemen nyeri pascabedah harus ditujukan ke arah pencegahan dan meminimalkan terjadinya proses sensitisasi. Analgesia multimodal dengan mengkombinasi obat yang menghambat sensitisasi perifer dan sentral, dengan opioid sebagai analgesia penyelamat dapat menjadi pilihan untuk memberikan manajemen nyeri yang adekuat dan meminimalkan efek samping. Current Practice for Post Operative Pain Management in Caesarean Section Abstract Caesarean section (CS) is frequently followed by moderate to severe pain up to 48 hours after surgery. Postoperative pain management is aimed to provide postoperative comfortness, inhibits nociceptive impulse, and blunts neuroendocrine response to pain, thus enhance the return of physiological function. Moreover, an adequate pain management in CS patients allows early mobilization in preventing the increased of thromboemboli risk during pregnancy, the need of patients to be pain free in taking care of the baby as well as effective breastfeeding. Postoperative pain mechanism consists of peripheral and central senzitisation of nervous system. Clinical impact of nervous system sensitization including hyperalgesia and allodynia. Postoperative sensitization resulted in patient’s suffering that increase morbidity and mortality rate eventually. Therefore, postoperative pain management should be directed to prevent and minimalize sensitization process. Multimodal analgesia by combining analgesics inhibited peripheral and central sensitization, with opioid as rescue analgesic may be preferred to provide adequate pain management and to minimalize the adverse effects.
Perbandingan Efektivitas Anestesi Spinal dengan Bupivacain 12,5 Mg dan Bupivacain 5 Mg yang ditambah Fentanyl 50 Mcg pada Seksio Sesarea Fritzky Indradata; Heri Dwi Purnomo; Muh. Husni Thamrin; Sugeng Budi Santoso; Ardana Tri Arianto; RTH Supraptomo
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.55

Abstract

Latar Belakang: Anestesi spinal mempunyai efek samping berupa hipotensi dan mual muntah. Tujuan: penelitian ini adalah membandingkan efek anestesi spinal bupivacain dosis normal 12,5 mg dan bupivacain dosis rendah 5 mg dengan fentanyl 50 mg pada seksio sesarea terhadap perubahan hemodinamik, ketinggian blok, onset, durasi dan efek samping. Subjek dan Metode: Penelitian double blind randomized control trial pada 36 pasien yang memenuhi kriteria. Pasien dibagi menjadi dua kelompok, yang masing-masing terdiri 18 pasien, kelompok 1 dilakukan anestesi spinal dengan bupivacain hiperbarik 5 mg ditambah adjuvan fentanyl 50 mcg, sedangkan kelompok 2 diberikan bupivacain hiperbarik 12,5 mg. Penilaian meliputi saat mula kerja blokade sensorik, mula kerja blokade motorik, durasi, tekanan darah, laju nadi, dan saturasi oksigen, lama kerja dan efek samping. Data hasil penelitian diuji secara statistik dengan uji chi-square. Hasil: Terdapat perbedaan signifikan pada onset dan durasi blokade sensorik dan motorik, bupivacain 12,5 mg lebih baik dibandingkan bupivacain 5 mg + fentanyl 50 mcg (p<0.05). Tidak ada perbedaan signifikan pada perubahan tanda vital dan efek samping (p>0.05). Simpulan: Bupivacain 12,5 mg menghasilkan onset lebih cepat dan durasi lebih lama dibandingkan bupivacain 5 mg + fentanil 50 mcg pada anestesi spinal untuk seksio sesarea Comparison of The Effectiveness Spinal Anesthesia with Bupivacaine 12,5 Mg and Bupivacaine 5 Mg added Fentanyl 50 Mcg in Caesarean Section Abstract Background: Spinal anesthesia has side effects such as hypotension and nausea and vomiting. Objective: The aim of this study was to compare the effects of spinal anesthesia with normal doses of 12,5 mg of bupivacaine and 5 mg of low-dose bupivacaine with fentanyl 50 mg in the cesarean section on hemodynamic changes, block height, onset, duration, and side effects. Subjects and Methods: Double-blind randomized control trial in 36 patients who met the criteria. Patients were divided into two groups, each consisting of 18 patients, group 1 underwent spinal anesthesia with 5 mg of hyperbaric bupivacaine plus 50 mcg of fentanyl adjuvant, while group 2 was given 12,5 mg of hyperbaric bupivacaine. Assessments include the initiation of sensory block action, onset of motor block action, duration, blood pressure, pulse rate, and oxygen saturation, duration of action, and side effects. The research data were statistically tested with the chi-square test. Results: There were significant differences in the onset and duration of sensory and motor blockade, bupivacaine 12,5 mg was better than bupivacaine 5 mg + fentanyl 50 mcg (p <0.05). There was no significant difference in changes in vital signs and side effects (p> 0.05). Conclusion: Bupivacaine 12,5 mg resulted in a faster onset and longer duration than bupivacaine 5 mg + fentanyl 50 mcg in spinal anesthesia for cesarean section.
Pengelolaan Anestesi untuk Seksio Sesarea Kehamilan Triplet dengan Skor LAS Intraoperatif 6 Dewi Yulianti Bisri; Tatang Bisri
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.56

Abstract

Triplet (kembar tiga) dan kehamilan kembar yang lebih banyak lagi (higher multiple gestations) dihubungkan dengan peningkatan morbiditas ibu dan anak dibandingkan dengan kehamilan ganda atau kehamilan tunggal. Seksio sesarea adalah rute yang disukai untuk melahirkan pasien dengan kehamilan triplet. Seorang wanita, 31 tahun, G1P0A0 gravida aterm triplet hasil inseminasi, BB 72,5 kg, TB 168 cm, Mallampati 1, tekanan darah 130/90 mmHg, laju nadi 97x/menit, SpO2 100% dengan kanul binasal. Induksi dengan propofol 140 mg, atracurium 35 mg, intubasi dengan pipa endotrakheal no 6,5. Ventilasi mekanik dengan volume tidal 560 mL, laju nafas 12 x per menit, postive end expiratory pressure (PEEP) 5. Rumatan anestesi dengan N2O 40%, sevofluran 1-2 vol%. Analgetik fentanyl 100 ug diberikan setelah bayi lahir. Cairan RL 1500 mL, gelofusin 500 mL. Obat-obat lain: misoprostol 800 mcg perrectal, oxytocin 40 IU, methylergometrine 0,6 mg, asam traneksamat 1 gram, dextrose 40% 25 mL. Bayi ke-1 BB 2650 gr, pada jam 19.1, Apgar score 1 menit dan 5 menit 9, 10, Bayi ke-2 BB 2100 gr, Apgar score 1 menit dan 5 menit 9, 10, Bayi ke-3 BB 1900 gr, Apgar score 1 menit dan 5 menit 9, 10 lahir selang 1 menit. Tidak terjadi hipotensi, dan karena skor linear analog scale (LAS) 4-6 setelah terapi medikal maka dilakukan pengikatan uterus dengan tehnik B-Lynch suture, tidak terjadi postpartum hemorrhage, Hb postoperatif 10 g/dL, hematokrit 29%, tidak dilakukan transfusi darah. Analgetik pascabedah dengan petidin 100 mg dan dexketoprofen 100 mg dilarutkan dalam NaCl 0,9% 500 mL yang diberikan untuk 24 jam. Anesthesia Management for Caesarean Section Triplet Pregnancy with Intraoperative LAS Score 6 Abstract Triplet and higher multiple gestations associated with increase maternal and fetal morbidity compare with twin or singleton pregnancy. Caesarean section is route for delivery patient with triplet gestations. A woman, 31 years, G1P0A0 gravida aterm triplet insemination result, BW 72,5 kg, height 168 cm, Mallampati 1, blood pressure 130/90 mmHg, heart rate 97x/minute, SpO2 100% with canul binasal. Induction anesthesia with propofol 140 mg, atracurium 35 mg, intubated with endotracheal tube no 6,5. Mechanical ventilation with tidal volume 560 mL, respiratory rate 12 x per minutes, postive end expiratory pressure (PEEP) 5. Maintenance anesthesia with N2O 40%, sevoflurane 1-2 vol%. Analgetic fentanyl 100 ug given after baby delivery. Fluids with RL 1500 mL, gelofusin 500 mL. Other drugs are misoprostol 800 mcg perrectal, oxytocine 40 IU, methylergometrine 0.6 mg, tranexamic acid 1 gram, dextrose 40% 25 mL. First baby BW 2650 gr, Apgar score 1 minute and 5 minute 9, 10 at 19.21, second baby BW 2100 gr, Apgar score 1 minute and 5 minute 9, 10, third baby BW 1900 gr, Apgar score 1 minute and 5 minute 9, 10 delivered 1 minute interval. No evidence of hypotension and linear analog scale (LAS) score is 4-6 and so needed uterus binding with B-Lynch suture technique, no evidence of postpartum hemorrhage, postoperative Hb 19 g/dL, hematocrit 29%, no blood transfusion. Postoperative analgesia with petidine 100 mg and dexketoprofen 100 mg in NaCl 0,9% 500 mL for 24 hours.
Anestesi untuk Seksio Sesarea pada Pasien dengan Ventrikel Septal Defek Dwiana Sulistyanti; Yusmein Uyun
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.58

Abstract

Pasien hamil yang memiliki penyakit jantung kongenital merupakan tantangan untuk dokter kandungan dan dokter anestesi ketika pasien akan menjalani operasi sesarea mergensi. Dalam penanganan pasien hamil yang beresiko tinggi dibutuhkan pemahaman yang baik tentang perubahan hemodinamik saat kehamilan, dan efek perubahan tersebut terhadap pasien dan fisiologi jantung abnormal. Penyakit jantung kongenital merupakan penyebab paling banyak masalah jantung pada pasien hamil tetapi pasien dengan defek yang tidak dikoreksi merupakan kasus yang jarang pada bagian kandungan. Pada populasi dewasa, lesi jantung kongenital kronik yang tidak diperbaiki merupakan situasi yang sulit bagi dokter anestesi karena tingginya resiko anestesi obstetrik. Laporan kasus ini menjelaskan tentang keberhasilan operasi sesar pada pasien penyakit jantung kongenital dalam kondisi emergensi. Wanita umur 28 tahun, G1P0A0 dengan umur kehamilan 38–39 minggu datang ke rumah sakit untuk melahirkan. Wanita ini memiliki riwayat penyakit jantung kongenital ventrikel septal defek (VSD). Kemudian dilakukan operasi sesar dengan anestesi umum dengan gas inhalasi dan obat intravena. Cefotaxim dan gentamisin diberikan untuk propilaksis endokarditis bakteri. Bayi lahir dengan skor APGAR 8 setelah menit ke 5. Pasca operasi pasien dibawa ke ruang ICU untuk monitoring ketat tanda vital dan perawatan pasca operasi. Laporan kasus ini menjelaskan tentang kondisi pasien pre-operasi, intra-operasi dan pasca-operasi. Anesthesia for a Cesarean Section in a Patient with Ventricular Septal Defect AbstractPregnant patient with congenital heart disease (CHD) make for a unique challenge to the obstetrician and anesthesiologist, when the patient has to undergo emergency cesarean section. Managing high-risk parturient requires a thorough understanding of the hemodynamic changes of pregnancy, its effect on the patient and physiology of the abnormal heart. CHD is becoming the most common source of cardiac problem in pregnant patient but non-corrected cardiac defect patient are rare cases in the obstetric departement. In adult population, chronic non-palliated congenital heart lession present new difficult situation for the anesthesiologist working with high-risk obstetric anesthesia. This case report makes a successful cesarean section in a CHD patient in emergency condition. A 28 year old female, gravida 1 at 38-39 weeks gestation age admitted to our hospital for delivery. She had a history of CHD with ventricular septal defect. She was prepared for cesarean section under general anesthesia with inhaled and intravenous anesthetic agents. Cefotaxim and gentamicin were administered for prophylaxis against bacterial endocarditis. The newborn was delivered quickly with APGAR score 8 after 5 minutes. Postoperatively, the patient was admitted to the intensive care unit (ICU) for close monitoring of vital signs and post-operative care. The case report will include details in pre-operative, intra-operative and post-operative outcome of the patient.
Manajemen Anestesi untuk Seksio Sesarea pada Pasien Pre Eklampsia Berat yang Terinfeksi Covid-19 RTH Supraptomo
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.59

Abstract

Komplikasi hipertensi tercatat 6–8% pada kehamilan dan menjadi kontributor yang signifikan morbiditas dan mortalitas maternal dan perinatal. Di Amerika Serikat, preeklamsia menjadi satu dari tiga besar penyebab utama kematian ibu hamil. Penanganan yang tidak sesuai dengan standar, sering menjadi penyebab utama yang menyebabkan peningkatan morbiditas dan mortalitas pada ibu hamil. Seorang wanita 30 tahun early warning score (EWS) score 6 dengan preeklampsia pada sekundigravida (G2P1A0) hamil preterm belum dalam persalinan, riwayat seksio sesarea 1x pro seksio sesarea transperitoneal emergensi dengan status fisik ASA IIE, direncanakan dilakukan anestesi dengan teknik regional anestesi sub-arachnoid block (SAB). Manajemen anestesi pada kehamilan dengan pre-eklampsia meliputi preoperatif, intraoperatif dan postoperatif. Pada masa pandemi COVID-19 dibutuhkan penggunaan alat pelindung diri (APD) yang memadai selama tindakan perioperatif. Perhatian khusus pada anestesi pasien terinfeksi COVID-19 meliputi penggunaan ruangan bertekanan negatif, meminimalisir instrumentasi jalan nafas, serta penggunaan APD level 3. Anesthesia Management for Caesarean Section in Severe Pre-Eclampsia Patients Infected with Covid-19 Abstract Hypertensive complications account for 6-8% of pregnancy and are a significant contributor to maternal and perinatal morbidity and mortality. In the United States, preeclampsia is one of the top three causes of death for pregnant women. Handling that is not in accordance with standards is often the main cause that causes increased morbidity and mortality in pregnant women. A 30-year-old woman with early warning score (EWS) score 6 with preeclampsia in secondary pregnancy (G2P1A0) who is preterm pregnant yet in labor, a history of cesarean section 1x pro-cesarean section emergency transperitoneal with ASA IIE physical status, planning to perform anesthesia with regional anesthesia technique. sub-arachnoid block (SAB). Anesthesia management in pre-eclampsia pregnancy includes preoperative, intraoperative and postoperative. During the COVID-19 pandemic, adequate personal protective equipment (PPE) is required during perioperative measures. Special attention to anesthesia for patients infected with COVID-19 includes the use of negative pressure rooms, minimizing airway instrumentation, and the use of level 3 PPE.
Kardiomiopati Peripartum: Manajemen Anestesi Terbaru Rafidya Indah Septica; Isngadi Isngadi
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.60

Abstract

Kardiomiopati peripartum (KMPP) atau Peripartum cardiomyopathy (PPCM) adalah kelainan jantung idiopatik dengan karakteristik disfungsi sistolik dan simptom gagal jantung pada akhir masa kehamilan atau beberapa bulan setelah kehamilan tanpa sebab lain yang mengancam jiwa maternal dengan risiko morbiditas dan mortalitas postpartum cukup tinggi. Penelitian terbaru dalam pemahaman tentang patofisiologi PPCM menunjukkan proses yang melibatkan faktor endotel dan faktor toksik kardio, seperti sFlt-1 dan 16 kDa prolaktin, sehingga kemampuan jantung beradaptasi terhadap kehamilan normal terlampaui pada ibu yang sudah rentan terhadap serangan jantung. Terapi spesifik PPCM belum dapat ditentukan. Bromokriptin yang bekerja memblok pelepasan prolaktin dari glandula pituitaria, pada beberapa penelitian awal menghasilkan perbaikan fraksi ejeksi ventrikel kiri secara bermakna. Penelitian lebih lanjut dengan jumlah sampel yang lebih besar masih harus dilakukan untuk terapi ini. Prinsip manajemen direkomendasikan sesuai dengan patofisiologi yang terjadi. Optimalisasi atau reduksi preload baik dengan reduksi natrium maupun cairan dan penggunaan diuretika, menurunkan afterload dengan vasodilator, dan memperbaiki kontraktilitas jantung dengan inotropik, dromotropik, atau inodilator adalah strategi utama yang direkomendasikan. Tidak ada perubahan strategi dalam manajemen terapi ini, tetapi pilihan teknik anestesi saat ini lebih berkembang ke analgesi/anestesi regional. Pemahaman penggunaan dosis dan konsentrasi anestetika lokal menjadi penting untuk mencapai target dalam strategi yang direkomendasikan. Peripartum Cardiomyopathy: Update in Anesthesia Management Abstract Peripatum cardiomyopathy (PPCM) is an idiopathic cardiomyopathy presenting with heart failure secondary to left ventricle systolic dysfunction towards the end of pregnancy or in the months following delivery, where no other cause for heart failure is identified, life-threatening, and postpartum high morbidity and mortality risk. Recent studies in the understanding of PPCM pathophysiology indicate that there’s processes involving endothelial and cardio-toxic factors such as e.g. sFlt-1 and 16 kDa prolactin, leading the heart’s capacity to adapt to a normal pregnancy may be exceeded in some women already susceptible to cardiac insult. Spesific therapy for PPCM can not be determined. Bromocriptine that blocks the release of a hormone called prolactine from the pituitary gland in some preliminary studies improved left ventricular ejection fraction significantly. Further research with larger sample size remains to be done for this therapy. Management principles for PPCM are recommended in accordance with the pathophysiology. Depending on the volume status, preload has to be optimized by either fluid administration or sodium restriction and diuretics, decrease afterload using vasodilator, and improve contractility by using inotropic, dromotropic, or inodilator are the main strategies. There is no change in management strategy for PPCM, but regional analgesia/anesthesia preferably for now. Understanding the dose and concentration administration of local anesthethic drugs are important to achieve targets recommendation.
Perbandingan Tiga Dosis Gabapentin Oral terhadap Nyeri Pascabedah, Sedasi, dan Mual-Muntah pada Histerektomi Total dengan Anestesi Spinal Rakhmat Ilhamsyah; Syafruddin Gaus; Faisal Muchtar; Abdul Wahab
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.62

Abstract

Latar Belakang: Gabapentin dapat mencegah nyeri nosiseptif, nyeri neuropatik, inflamasi akut dan mengurangi nyeri pasca operasi. Tujuan: penelitian ini membandingkan tiga dosis gabapentin oral pada operasi histerektomi total dengan anestesi spinal untuk efeknya pada sedasi, mual-muntah, dan nyeri pascabedahSubjek dan Metode: Desain yang digunakan pada penelitian ini adalah uji klinis acak tersamar tunggal. Sampel terbagi dalam kelompok G600: gabapentin 600 mg, kelompok G750 gabapentin 750 mg dan kelompok G900: gabapentin 900 mg dengan jumlah sampel masing-masing 14 orang. Data dianalisis menggunakan uji statistik uji Mann Whitney U.Hasil: Perbandingan analgesik tambahan pascabedah kelompok G600 membutuhkan lebih banyak analgesik tambahan dibanding kelompok G750 (p = 0,021) dan begitu juga untuk kelompok G750 dibanding kelompok G900(p = 0,004). Perbandingan kelompok G600 dan G750 untuk skor sedasi dan agitasi Richmond berbeda bermakna pada jam ke-3,6, dan 9 (nilai p 0,004; 0,007; dan 0,03) dan kelompok G600 dan G900 juga berbeda bermakna pada jam ke-3,6, dan 9 (p = 0,007). Untuk post operative nausea and vomiting (PONV) terdapat perbedaan bermakna antara kelompok G600 dan G900 dan juga antara kelompok G750 dan G900 (p = 0,043). Simpulan: Pemberian gabapentin oral 900 mg memberikan total rescue analgetik paling sedikit dibanding dengan pemberian gabapentin 600 mg dan 750 mg. Ketiga kelompok gabapentin mengalami efek samping sedasi ringan. Kejadian PONV paling rendah pada kelompok gabapentin 900 mg. Comparison Between Three Doses of Oral Gabapentin Against Postoperative Pain, Sedation, and Nausea-Vomiting in Total Hysterectomy with Spinal Anesthesia Abstract Background: Gabapentin can prevent nociceptive pain, neuropathic pain, acute inflammation and reduce postoperative painObjective: this study aimed to compare three doses of oral gabapentin in total hysterectomy with spinal anesthesia for its effect on sedation, postoperative nausea and vomiting, and post operative painSubject and Method: This study was a single blind randomized clinical trial. Samples were divided into groups of G600: gabapentin 600 mg, group G750 gabapentin 750 mg and group G900: gabapentin 900 mg with the number of samples was 14 people each. Data were analyzed using statistical analysis using the Mann Whitney U test.Results: Comparison of postoperative adjunctive analgesics in the G600 group required more additional analgesics than the G750 group (p = 0.021) and likewise for the G750 group compared to the G900 group (p = 0.004). Comparison of the G600 and G750 groups for sedation and agitation scores for Richmond was significantly different at the 3.6 and 9 hours (p value 0.004; 0.007; and 0.03) and the G600 and G900 groups were also significantly different at the 3.6 hour, and 9 (p = 0.007). For post operative nausea and vomiting (PONV), there were significant differences between the G600 and G900 groups and also between the G750 and G900 groups (p = 0.043).Conclusion: Gabapentin oral 900 mg with the least total analgesic rescue compared to gabapentin 600 mg and 750 mg. All three gabapentin groups experienced mild side effects of sedation. The lowest incidence of PONV was in the gabapentin 900 mg group
Anestesi Spinal untuk Seksio Sesarea pada Wanita Hamil dengan Obesitas Morbid Alfathah Bania Lubis; Tatat Agustian; Djoni Kusumah Pohan; Alexander Siagian
Jurnal Anestesi Obstetri Indonesia Vol 4 No 1 (2021): Maret
Publisher : Indonesian Society of Obstetric Anesthesia and Critical Care (INA-SOACC)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47507/obstetri.v4i1.64

Abstract

Obesitas adalah keadaan tubuh yang terjadi akibat akumulasi lemak yang abnormal atau berlebih sehingga dapat menimbulkan banyak implikasi klinis dalam tatalaksana anestesi. Wanita hamil dengan berat badan lebih dan obesitas merupakan kondisi yang berisiko tinggi dan terbukti berhubungan dengan peningkatan komplikasi dalam kehamilan. Wanita dengan obesitas sangat penting diberikan edukasi untuk menurunkan berat badan dalam merencanakan kehamilan dan perlu diinformasikan tentang peningkatan risiko termasuk persalinan dengan bedah sesar. Seorang wanita 34 tahun G2P0A1 hamil 41 minggu dengan obesitas morbid dengan tinggi badan 156 cm dan berat badan 124 kg dengan nilai indeks massa tubuh (IMT) 50,9 kg/meter2. Pasien menjalani seksio sesarea dengan teknik anestesi spinal, dengan puncture di L3-4 median, menggunakan obat levobupivakain 15 mg + fentanyl 25 mcg. Operasi berlangsung 1 jam 15 menit, perdarahan 350 ml, hemodinamik stabil. Lahir bayi laki-laki, BB 3100 gram, PB 51 cm, APGAR score 8-9-10. Pemilihan teknik anestesi pada wanita hamil dengan obesitas yang akan menjalani seksio sesarea dilakukan dengan jenis anestesi regional yaitu anestesi spinal dengan pertimbangan dapat mengurangi terpaparnya obat-obatan terhadap bayi, mengurangi risiko aspirasi pneumonia dan memungkinkan proses lahirnya bayi dalam keadaan ibu sadar, dapat digunakan untuk mengatasi nyeri pasca operasi, dan juga dapat menghindari risiko bila dilakukan dengan teknik anestesi umum. Simpulan: Wanita hamil dengan berat badan lebih dan obesitas perlu penilaian kondisi dan perencanaan anestesi yang tepat untuk menurunkan risiko seksio sesarea Spinal Anesthesia for Caesarean Section in Pregnant Woman with Morbid Obese Abstract Obesity is a state of the body that occurs due to abnormal or excess fat accumulation that can cause many clinical implications in the management of anesthesia. Overweight and obese pregnant women are at high risk and have been shown to be associated with increased complications in pregnancy. Obese women are very important to be educated to lose weight in planning pregnancy and need to be informed about increased risks including delivery by cesarean section. A female, 34 years old G2P0A1, 41 weeks pregnant with morbid obese, 156 cm tall and weight of 124 kg, with BMI 50,9 kg/meter2. Carried out in spinal anesthesia technique with puncture in L3-4 median, using levobupivacain 15 mg + fentanyl 25 mcg. The operation lasted for 1 hour and 15 minutes, with 350 ml bleeding, hemodynamically stable. Born a baby boy, BW 3100 gram, BL 51 cm, APGAR score 8-9-10. Anesthesia technique for pregnant woman with obese who will undergo Caesarean Section is regional anesthesia type called spinal anesthesia with consideration to reduce drug intake for baby, lessen chance of pneumonia aspiration and enable birth process while mother still awake, can be used for overcome post-operation pain, and to avoid risk if done by general anesthesia. Conclusion: overweight and obese pregnant women need proper condition assessment and anesthetic planning to reduce the risk of cesarean section.

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